In Reply.—Brayden raises some interesting issues regarding the diagnosis of sexual abuse. However, it would be a minimalist role for pediatricians to only report the history and physical findings. Indeed, pediatricians (and others) need to interpret the information and make a (perhaps tentative) assessment of the likelihood of abuse to make a report to child protective services. This decision does need to be guided by state law. In addition, child protective services should be interested in the pediatrician's findings and assessment.
Few caseworkers, lawyers, or judges are in a position to interpret the physical findings. Although a final decision on the likelihood of abuse may be made by the public agencies, a comprehensive assessment and well-reasoned opinion facilitates this process. The distinction between a medical opinion and a diagnosis appears to be largely semantic. Clearly, if the diagnosis is uncertain, appropriate caution is warranted.
In addition to state reporting